Junaid Ahmad1* and Mokbul Morshed Ahmad2
*1Disaster Preparedness Mitigation & Management, Asian Institute of Technology, Thailand
2Regional and Rural Development Planning; School of Environment, Resources and Development (SERD),


Background: Over the last two decades, earthquakes across the world have taken millions of human lives and caused countless injuries. Since 2005, in Pakistan alone, more than 0.1 million people lost their lives, and millions of others suffered physical and psychological injuries due to natural disasters. However, limited information is available on how these natural disasters, such as earthquakes, impact healthcare institutions and communities and how the aftereffects of these events are reflected in global health indicators Objective: We aim to assess how earthquakes impact communities’ public health and healthcare service providers’ institution by using select global health indicators.

Methods: We used a retrospective cohort study designed by retrieving ten districts’ monthly data regarding parts of the population that attended public health facilities for primary health care services, which include antenatal care, immunization, vector-borne diseases (malaria), waterborne diseases (diarrhoea or dysentery), and airborne diseases (tuberculosis). These ten districts have a combined population of 7.78 million. As the result of an earthquake, more than 75,000 deaths and 180,000 injuries were recorded in the 2005 Kashmir earthquake, and 275 deaths and 1,980 injuries were recorded in the earthquake of October 2015. For our study, the ten districts were organized into two main groups, each group including five districts each, with the determining criteria being the most affected and least affected by the earthquake in terms of injuries, deaths, and collapsed structures. Monthly data over six years, from January 2011 to November 2016, was retrieved from the District Health Information System (DHIS) database, which has a reporting compliance of 100% for the study sites, and maintain health data of 7.78 million people. Using specific indicators, we employ a time-series, retrospective analysis to assess earthquake-induced public health risks and vulnerabilities.

Results: We determine, uniquely, that the geographic area most affected by the earthquake in 2015 is the area with the highest tuberculosis (TB) prevalence rate. Further, the number of confirmed cases and even deaths from malaria remain extremely low after the earthquake incident; however, at the same time, the suspected malaria incidence rate is significantly higher. From the data collected in both regions, pneumonia appears to have slight cyclical variations in its incidence rate depending on the season.

Conclusions: By analyzing selected health indicators before and after the earthquake, it is clear that earthquakes impact public health and cause various vulnerabilities. Some indicators are significantly affected by the earthquake while others are not considerably affected at all. Although it is likely not possible to do a real-time analysis in the time of an earthquake, we conclude that a retrospective analysis can somewhat mitigate the adverse impact of an earthquake on a community’s public health and the institutions that provide health services to communities by using global health indicators.


The primary author is thankful to the Higher Education Commission of Pakistan for funding the author’s doctoral study. Also, many thanks are given to the University of Granada (Spain) and Erasmus Mundus for funding the research mobility collaboration between the co-authors, which otherwise would not have been possible. We are also grateful to Government of Khyber Pukhtunkhwah, Pakistan and the Directorate General Health Services for allowing us to access the complete database, District Health Information System (DHIS).